Abstrakt

Rapid and sustained resolution of dysthyroid optic neuropathy with teprotumumab monotherapy

Michael L. Fasano, Matthew D. Kay

Purpose: We describe the first case of a patient who had rapid and sustained resolution of severe dysthyroid optic neuropathy with teprotumumab therapy without prior medical, surgical, or radiotherapeutic intervention.

Observations: An 83 year-old-man with no prior history of thyroid disease and an ocular history of strabismus surgery as a child presented with progressive visual loss, diplopia, and eyelid swelling. Visual field testing demonstrated double arcuate scotomata denser inferiorly in the left eye (OS) and peripheral depression in the right eye (OD). He was offered treatment options of intravenous steroids, high dose oral steroids, or surgery but refused given concern for side effects. Teprotumumab was initiated with close observation, and he demonstrated improvement of his field defect after one infusion and resolution after three infusions of teprotumumab. He has since completed his 8 dose, 24 week course of teprotumumab and his visual acuity and optic nerve function remain stable.

Conclusion: Teprotumumab may be a safe and effective sole therapeutic agent for rapid and sustained resolution of dysthyroid optic neuropathy. Further studies may be warranted.